Nicholas Carroll Destefano, MD is a medicare enrolled "General Practice" physician in Fort Gordon, Georgia. His current practice location is
300 E Hospital Rd, Fort Gordon, Georgia. You can reach out to his office (for appointments etc.) via phone at
(706) 383-5299.
Nicholas Carroll Destefano is licensed to practice in Nebraska (license number 30177) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1154776755.
Physician's Profile
Full Name | Nicholas Carroll Destefano |
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Gender | Male |
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Speciality | General Practice |
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Location | 300 E Hospital Rd, Fort Gordon, Georgia |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1154776755
- Provider Enumeration Date: 05/02/2016
- Last Update Date: 09/20/2023
Medicare PECOS Information:
- PECOS PAC ID: 0446542229
- Enrollment ID: I20170802002850
Medical Identifiers
Medical identifiers for Nicholas Carroll Destefano such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1154776755 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
208D00000X | General Practice | 30177 (Nebraska) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Nicholas Carroll Destefano is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Nicholas Carroll Destefano, MD 300 E Hospital Rd, Fort Gordon, GA 30905 Ph: (706) 383-5299 | Nicholas Carroll Destefano, MD 300 E Hospital Rd, Fort Gordon, GA 30905 Ph: (706) 383-5299 |
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